Fecal transplants fight superbug

Doctors: Aim is to use good bacteria to fight bad

by Lauran Neergaard - Dec. 14, 2010 12:00 AMAssociated Press

WASHINGTON - A superbug named C. diff is on the rise, a germ that so ravages some people's intestines that repeated tries of the strongest, most expensive antibiotic can't conquer their disabling diarrhea.

Now a small but growing number of doctors are trying a last-ditch treatment: Using good bacteria to fight off the bad by transplanting stool from a healthy person into the sick person's colon.

Yes, there's a yuck factor. But reports of several dozen cases in a medical journal and at a meeting of the nation's gastroenterologists this fall suggest that with no more inconvenience than a colonoscopy, people who have suffered C. diff for months, or longer, can rapidly improve.

"This is the ultimate probiotic," says Dr. Lawrence Brandt of New York's Montefiore Medical Center, who has performed 17 of the procedures.

Yet it's much more complex: An entire bacterial neighborhood is transplanted, almost like an organ transplant minus the anti-rejection drugs, says Dr. Alexander Khoruts of the University of Minnesota. He took a genetic fingerprint of the gut bacteria in a woman left emaciated after eight months of severe C. diff. Not only did the diarrhea disappear after a fecal transplant, but that normal bacteria mirroring her husband's - the donor - quickly took root in her recovering intestine.

Here's the caution: Fecal transplants haven't been studied in the way that science requires to prove they work - by comparing similar patients given either a transplant or more intense antibiotics. History is full of failed treatments that doctors thought promising until they were put to a real test.

"There's very good reason to think this fecal transplantation, or bacteriotherapy, might work, but it needs to be proven before everybody starts to do it," stresses Dr. Lawrence Schiller, a gastroenterologist with the Baylor Health Care system in Dallas. He followed reports on the treatment at the American College of Gastroenterology's recent meeting, but hasn't joined the fledgling trend.

C. diff, formally named Clostridium difficile, has become a menace in the nation's hospitals, and can spread outside of them, too. Some patients suffer just mild diarrhea, but others can develop colitis.